Wednesday, October 12, 2011

Question 5

Dear Dr. T.,

My husband’s father is eighty nine years old. He is very frail and wheelchair bound. To remain at home he needs extensive and expensive home health care. At one time he had substantial financial assets but these are rapidly dwindling due to the cost of his care. Medicare would pay for his care if he was placed in a nursing home, and he would have money left to leave his grandchildren – which is his wish. But he is happy at home and would be miserable in a nursing home. His father’s mind is quite clear and judgment is good, but my husband, who has Power Of Attorney and signs all of the checks, doesn’t tell him how much his care costs nor that his money is being used up, because he wants his father to be happy and it would make him worry if he knew. He just might choose to give up his expensive care and allow himself to end his days in a nursing home so that his grandchildren could benefit from the money he leaves behind. By not discussing all of this with him are we unfairly denying him the right to self determination? Or are we looking after his best interests?

Conflicted

Dear Conflicted,

It is clear that both you and your husband care very much for your father-in-law and also that you are caught in an ethical dilemma, as expressed in your question: to allow a man with a clear mind and sound judgment to know what his situation is and to decide his own fate or to shelter him from the truth so that he will continue to be happy at home. There are two opposing values here and your husband has chosen one. A hard choice is being made and far be it for me to question you husband’s choice. One of the things I notice in the story you tell is what is missing. Your father-in-law, despite – or perhaps because of – his clear mind and sound judgment has turned over the management of his financial affairs to his son. He is not asking your husband for an accounting of what is being spent. At this stage of life many people want to be taken care of and not to have to make the hard decisions. They don’t want to have to worry about money. I think your husband is doing just what his father wants by making the hard choices for him.